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HOW DID YOU FIND OUT ABOUT INTENT PHYSIO? *
WHAT SERVICE OPTION ARE YOU INTERESTED IN? *
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WHERE ON YOUR BODY ARE YOU EXPERIENCING THE ISSUE? (PLEASE CHECK ALL THAT APPLY) *
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HOW LONG HAVE YOU BEEN EXPERIENCING THIS ISSUE? *
HOW IMPORTANT IS THIS ISSUE, AND HOW SERIOUS ARE YOU ABOUT TAKING ACTION TO FIND A SOLUTION? *
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PLEASE BRIEFLY DESCRIBE WHAT IS GOING ON... *
WHAT SPORT AND/OR ACTIVITIES IS THIS ISSUE CURRENT PROHIBITING YOU FROM DOING? *
WHAT KIND OF AN IMPACT WOULD SOLVING THIS ISSUE HAVE ON YOUR LIFE? *
PLEASE LIST 2-3 DAYS/TIMES WHICH WORK BEST FOR A FREE PHONE CONSULTATION TO DISCUSS HOW INTENT PHYSIO MAY BE ABLE TO HELP: *
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